Choi Soojin, Kim Dae Hyun, Kang Won Jun, Kim Yong Wook
Department of Physical Medicine and Rehabilitation, Hanyang University Medical Center, Seoul, Republic of Korea.
Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea.
Front Neurol. 2025 Jul 21;16:1641045. doi: 10.3389/fneur.2025.1641045. eCollection 2025.
Pathological laughing and crying (PLC) is characterized by sudden, uncontrollable, and inappropriate episodes of laughter or crying. While previous studies have identified PLC-associated structural lesions, the underlying metabolic alterations in these patients remain unclear.
We aimed to investigate cerebral metabolic alterations in patients with PLC following pontine stroke using F-fluorodeoxyglucose-positron emission tomography imaging.
In this retrospective study, we included 49 patients with pontine stroke admitted to a tertiary inpatient rehabilitation hospital between January 2011 and December 2021. Patients were classified into PLC ( = 20) and non-PLC ( = 29) groups. F-fluorodeoxyglucose-positron emission tomography images obtained within 14 days of admission were analyzed using the SPM 12 software. Voxel-wise two-sample t-tests were performed to compare brain metabolism between the two groups ( < 0.05). Multiple regression analysis was conducted to identify brain regions significantly associated with PLC severity, adjusting for age and stroke lesion volume.
Compared with that of the non-PLC group, the PLC group exhibited significant hypometabolism in the right superior frontal gyrus ( < 0.05). Multiple regression analysis revealed that decreased metabolism in the right inferior and middle temporal gyri was significantly correlated with higher Pathological Laughter and Crying Scale scores, indicating greater PLC severity. No brain regions showed positive correlations with the Pathological Laughter and Crying Scale scores.
Our findings reveal that PLC following pontine stroke is associated with distinct patterns of hypometabolism, particularly in the right superior frontal gyrus and the right inferior and middle temporal gyri. These regions may contribute to the regulation of emotional expression and provide insights into the neural mechanisms underlying PLC.
病理性哭笑（PLC）的特征是突然出现、无法控制且不适当的哭笑发作。虽然先前的研究已经确定了与PLC相关的结构病变，但这些患者潜在的代谢改变仍不清楚。
我们旨在使用F-氟脱氧葡萄糖正电子发射断层扫描成像技术，研究脑桥卒中后PLC患者的脑代谢改变。
在这项回顾性研究中，我们纳入了2011年1月至2021年12月期间在一家三级住院康复医院住院的49例脑桥卒中患者。患者被分为PLC组（n = 20）和非PLC组（n = 29）。使用SPM 12软件分析入院后14天内获得的F-氟脱氧葡萄糖正电子发射断层扫描图像。进行体素水平的双样本t检验，以比较两组之间的脑代谢情况（P < 0.05）。进行多元回归分析，以确定与PLC严重程度显著相关的脑区，并对年龄和卒中病变体积进行校正。
与非PLC组相比，PLC组右侧额上回存在明显的代谢减低（P < 0.05）。多元回归分析显示，右侧颞中回和颞下回代谢减低与病理性哭笑量表得分较高显著相关，表明PLC严重程度更高。没有脑区与病理性哭笑量表得分呈正相关。
我们的研究结果表明，脑桥卒中后的PLC与不同模式的代谢减低有关，特别是在右侧额上回以及右侧颞中回和颞下回。这些区域可能有助于调节情绪表达，并为PLC的神经机制提供见解。
